Correlation between HRCT chest findings, Spirometry, ABG and 2D ECHO in patients with bronchiectasis

BACK GROUND: Since bronchiectasis continues to be a common disease in our country with significant morbidity due to complications like repeated acute exacerbations and chronic respiratory insufficiency. AIM: This study was done to assess whether the type of Bronchiectasis and the extent of involvement have any correlation with pulmonary arterial hypertension and right heart dysfunction and correlate these findings with impairment of lung function and pulmonary gas exchange. Materials and methods: This was a prospective observational study conducted over a period of one year. Patients who presented with clinical features and CXR findings consistent with Bronchiectasis at Government chest Hospital / Andhra medical college, were subjected to HRCT Thorax, for confirmation of disease and to assess extent of involvement. 60 patients were included in the study. Demographic and clinical data were collected , routine blood investigations, ABG analysis on room air, spirometry and2D ECHO were done in all the patients and data were analysed. Results: Of the 60 patients included in the study, 34 patients (57%) were men and 26 patients (43%) were women. The mean age was 35.9 years (SD + 13.4 YRS) Majority of the study group 48/60 (80%) had cystic Bronchiectasis,16.7% of cases (10/60) had cylindrical Bronchiectasis and 2 patients had varicose Bronchiectasis. Lingula was considered as a separate lobe. The lobar distribution of Bronchiectasis was described as wide spread and extensive if 5/6 lobes involved. 12 had extensive disease and all of them belonged to cystic variety and were associated with severe ventilatory impairment and some of them also associated with gas exchange abnormalities like hypoxemia and hypercapnea leading to PAH and right ventricular dysfunction. Mixed ventilator pattern was the most commonly observed defect. The mean values of FEV1/FVC, FEV1 AND FVC were lower in patients with cytic bronchiectais than the mean values in patients with cylindrical bronchiectasis. Of the 60 patients 4 showed hypoxemia and 3 showed hypercapnea all of them belonged to cystic type of bronchiectasis with wide spread disease. In cystic bronchiectasis patients there was a significant negative correlation between RVSP and PaO2 and mildly significant positive correlation with PaCO2 and no significant correlation with FEV1. In patients with cylindrical type there was no correlation between RVSP and FEV1,Pao2 and PaCO2. Conclusion: Mixed ventilator defects, abnormal gas exchanges ,development of pulmonary hypertension and right ventricular dysfunction are more common in cystic than cylindrical type of bronchiectasis. Significant correlation between RVSP and PaO2 suggests chronic hypoxia has a central role in development of pulmonary hypertension and right ventricular dysfunction. Therefore aggressive management of pneumonias, childhood respiratory infections and early detection of bronchiectasis are important since severe forms are associated with several complications and morbidity.